Open treatment of mandibular fracture with external fixation
CPT4 code
Name of the Procedure:
Open Treatment of Mandibular Fracture with External Fixation
Summary
Open treatment of a mandibular fracture with external fixation is a surgical procedure used to repair a broken lower jaw (mandible). This involves accessing the fracture through an incision and stabilizing the bones using external devices, such as pins and rods, that are fixed outside the skin.
Purpose
The procedure is performed to stabilize and align a fractured mandible, ensuring proper healing. The goal is to restore normal jaw function, appearance, and prevent complications such as misalignment of the teeth or infection.
Indications
- Severe or complex fractures of the mandible
- Open fractures where the bone protrudes through the skin
- Fractures that are poorly aligned or unstable
- Multiple fractures or other facial injuries
Preparation
- Patients may need to fast for 6-8 hours prior to surgery.
- Discuss any medications with your doctor; some may need to be stopped.
- Pre-operative imaging tests such as X-rays, CT scans, or MRIs to assess the extent of the fracture.
- Blood tests and health evaluation to ensure the patient is fit for surgery.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A facial or intraoral incision is made to expose the fractured bone.
- Fracture Alignment: The bones are realigned correctly.
- Fixation: Metal pins or screws are inserted into the bone fragments through the skin. These are connected to a frame or rod outside the skin to hold the bone in place.
- Closure: The incision is closed with sutures.
Duration
The procedure typically lasts between 2 to 4 hours, depending on the complexity of the fracture.
Setting
The procedure is performed in a hospital operating room or a specialized surgical center.
Personnel
- Oral and maxillofacial surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technicians
Risks and Complications
- Infection at the incision or fixation sites
- Bleeding
- Nerve injury causing facial numbness or weakness
- Poor alignment or healing of the fracture
- Scarring
- Need for additional surgeries
Benefits
- Proper alignment and stabilization of the jaw
- Restoration of normal jaw function and appearance
- Reduced risk of complications such as malocclusion (misaligned bite)
Recovery
- Hospital stay for monitoring for 1-2 days
- Pain management with prescribed medications
- Soft diet or liquid diet initially
- Follow-up appointments for adjustment or removal of the external fixation
- Full recovery may take 3-6 months
Alternatives
- Closed reduction and internal fixation, where the fracture is aligned without an incision and fixed internally
- Conservative management with immobilization if the fracture is minor
- Pros and cons: External fixation is often used for complex fractures where other methods may not provide adequate stabilization.
Patient Experience
Patients will experience some discomfort and swelling immediately after the procedure, managed with pain medication. Eating and speaking may be initially difficult, but these functions should improve as healing progresses. Regular follow-up visits to monitor healing and adjust the fixation device will be necessary.